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Special Communication
Less Is More
October 2017

Eliminating Creatine Kinase–Myocardial Band Testing in Suspected Acute Coronary Syndrome: A Value-Based Quality Improvement

Author Affiliations
  • 1Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Baltimore, Maryland
  • 2Division of Cardiology, Department of Medicine, Mayo Clinic, Rochester, Minnesota
  • 3Division of Cardiology, Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland
JAMA Intern Med. 2017;177(10):1508-1512. doi:10.1001/jamainternmed.2017.3597

Cardiac biomarker testing is estimated to occur in nearly 30 million emergency department visits nationwide each year in the United States. The American College of Cardiology/European Society of Cardiology indicate that cardiac troponin is the biomarker of choice owing to its nearly absolute myocardial tissue specificity and high clinical sensitivity for myocardial injury. Multiple academic medical centers have implemented interventions to eliminate the routine ordering of creatine kinase–myocardial band tests, with published patient safety outcomes data; however, creatine kinase–myocardial band testing is still ordered in many hospitals and emergency departments. Eliminating a simple laboratory test that provides no incremental value to patient care can lead to millions of health care dollars saved without adversely affecting patient care quality, and in this case potentially improving patient care.